Alternative minimally invasive approaches

The aim of this publication is to touch on selective examples of novel accesses to the chest, which are more minimal than the conventional triportal, or Robotic surgery. Thoracic surgery has moved quickly from open thoracotomy to video assisted thoracoscopic surgery (VATS) to robotic assisted thoracoscopic surgery (RATS) in less than 20 years. Making minimal invasive surgery more minimal is driven by many factors such as improved patient experience, cosmesis and industry opportunities. Some of these approaches will die a natural death; others will be a major milestone for future developments. Whereas it is easy to be skeptical and critical about new approaches, we are reminded how we felt about thoracotomy when we started a VATS programme. Therefore, new approaches should be seriously studied and peer reviewed, at the behest of them becoming fully adopted and recognized as standard by the generations to come.